What’s New in Trauma Therapy – Dr. Bessel van der Kolk – HPP 75
Trauma has caused much grief and suffering for a lot of people, and it’s crucial for us, as care providers, to really understand why and how trauma started for each of our patients. There is still a lot to discover and learn when it comes to the conversation around trauma, and thanks to constantly evolving technology, we develop new ways of dealing with these challenges.
With all these technological advancements and methods of treatment available, where does the line end in terms of simply prescribing medicines that don’t really prove very effective in the long run versus opting for an integrative treatment approach? What are the concepts that we need to be aware of regarding the different stages of development in an individual and when the trauma specifically entered? Could that perhaps help us, as providers, choose a much suitable method of treatment?
In today’s episode, we are excited and deeply honored to be joined by a highly influential researcher, psychiatrist and pioneer, Dr. Bessel Van Der Kolk. Join us as we immerse in conversation surrounding modern psychiatry and psychotherapy, EMDR therapy, the fascinating data around brain activity in patients suffering from trauma, and a whole lot more.
The State Of Psychiatry Today – 02:25
“And EMDR was the deliberation of like, wow, there’s a whole other world that gets us out of our core paradigms. I think the mainstream of our field is still stuck in the old paradigm, particularly psychiatry, which has become a bucket bunch of drug pushers instead of therapists, which is very sad for the profession”
Psychiatry: Understanding EMDR – 04:56
“And so it’s very clear to me at the core is that where you become traumatized, your whole system gets desynchronized from your environment and from itself basically. Your system gets stuck—Because I think EMDR is a fantastically interesting method, in that people are deeply triggered by a particular reliving experience, you do these funny eye movements”
Human Trauma: An Evolutionary Perspective – 10:13
“Basically, it’s the way that the organism survives for the moment by becoming hyper vigilant and, or shutting yourself down. But it doesn’t promote interpersonal contact, it doesn’t promote care of the young, it doesn’t promote community organization, I think it’s really to end stage thing, and is already in our current state of civilization”
The Issue Of Shame – 12:38
“these very pervasive feelings of self-loathing, shame, self-hatred, that is the inevitable consequence of early childhood trauma and also the very clear indication that telling people that they shouldn’t be ashamed or it wasn’t their fault or doing anything cognitive doesn’t make any difference in the world whatsoever, except it helps people to understand how crazy it is that they continue to feel this way”
Psychedelics In PTSD Treatment – 21:02
“I was part of that first generation ever to discover psychotropic drugs and think that we’re the answer. And so I did the first studies on Prozac for PTSD, sort of PTSD, propel of PTSD, and we were filled with optimism. It turns out, it didn’t work all that well”
The MAPS Approach In Treatment – 26:19
“What we do in our MAPS studies is ketamine assisted psychotherapy, MDMA assisted psychotherapy, that create a context where people can safely go into an altered state of consciousness with people around you, who are really there for you, or hold you”
Trauma Therapy In The Future – 32:35
“I think neurofeedback is a huge thing for the future, when you start looking at these brain scans this quantitative EEG You see how the back of the brain is supposed to be really calm, sort of monitoring your bodily self is just going crazy. You see these abnormal brain waves, you see different parts of the brain not talking to each other”
Keith Kurlander, Dr. Will Van Derveer, Dr. Bessel Van Der Kolk
Dr. Bessel Van Der Kolk 00:00
I think all the great advances in humanity have probably been forged by traumatized people, because if you’re not traumatized life is okay the way it is. Why should you make any changes? When you’re traumatized, you have to find new solutions.
Dr. Will Van Derveer 00:18
Thank you for joining us for the higher practice podcast. I’m Dr. Will Van Derveer with Keith Kurlander. And this is the podcast where we explore what it takes to achieve optimal mental health. Well, I’m really excited about this episode, because we got to interview one of my heroes in the world of psychiatry and specifically in the world of trauma, trauma research, trauma understanding, trauma therapy. Bessel Van Der Kolk is a giant in the world of trauma. And we got to ask him some of the questions that I’ve had for him over many decades of following his work. So I’m very happy to introduce Bessel Van Der Kolk. His book “The Body Keeps The Score” is a must read for anyone who is in the field working with trauma. Bessel Van Der Kolk has for decades studied how children and adults adapt to traumatic experiences. And he has translated emerging findings from neuroscience and attachment research to develop and study a wide range of treatments for traumatic stress in children and adults. He did some of the first studies on the effects of SSRIs for PTSD, which is something he talks about in this episode. And he was a member of the first neuro imaging team to investigate how trauma changes brain processes. And he did the first research, connecting borderline personality disorder and deliberate self-injury to trauma and neglect in early childhood. He has focused his research on innovative treatments such as EMDR, and yoga and neurofeedback. And he recently established Trauma Center, a research lab studying the effects of neurofeedback and MDMA, on behavior of mood and executive functioning. Welcome Bessel Van Der Kolk. Dr. Van Der Kolk, thank you for joining us on the show.
Dr. Bessel Van Der Kolk 02:24
It’s a pleasure. Thank you.
Dr. Will Van Derveer 02:25
It’s wonderful to have you, we are really excited to have this opportunity with you and grateful for you taking your time away from your busy schedule to answer some questions with us. Well, one thing that we’re really curious about in terms of starting a conversation with you is, I wanted to thank you personally for your pioneering work in the 90s with looking at EMDR and the brain effects of EMDR. Because that really paved the way for me as a resident to go out and get trained in EMDR and begin using it before it was really in the mainstream. So I want to thank you for that.
Dr. Bessel Van Der Kolk 02:59
Really, EMDR, for me, was really also the opening in EMDR such bizarre methods. And we should really acknowledge how bizarre it is. And it works. And so for me, EMDR was the first thing I did to the traumatized people that really works. And for me, it’s the opening like, Oh, it’s bizarre, maybe other bizarre things work also. And then so later on, I learned that standing on one foot and putting your butt in the air, and breathing in funny ways also changed people and then tapping acupressure points or putting electrodes in people’s heads and having them change what they say. And so it really got us out of this Western paradigm. You either give people drugs, or you Yak. And EMDR was the deliberation of like, wow, there’s a whole other world that gets us out of our core paradigms. I think the mainstream of our field is still stuck in the old paradigm, particularly psychiatry, which has become a bucket bunch of drug pushers instead of therapists, which is very sad for the profession.
Dr. Will Van Derveer 04:08
I agree. And it’s something that Keith and I stand for, we run an institute where we teach psychiatrists other ways of helping people get well, and in particular, related to your work. We stand for somatic therapies as a really important component of getting well from trauma. I’m wondering about your sense, over the arc of the last 20 years with EMDR and the beginning and then moving into other strange ways of getting well. What is your sense of what is most effective in terms of working with trauma in the body versus what EMDR specifically is most suitable for in terms of single event trauma or developmental trauma? How do you think about the different ways to approach somatic healing with trauma at this point in time?
Dr. Bessel Van Der Kolk 04:56
Well, I think first of all, we need to acknowledge that this field is at most 30 years old. And the other thing is that we’re living in a capitalist egomaniac society, where everybody puts their own message forth as the answer. And so we’re very young, and there is not one answer, and I think the field keeps continually evolving. And as it’s very important for us to realize that what therapists or psychiatrists do, is a very small part of the whole overall healing process. So, for me, maybe the most profound experience I had was following Bishop Tutu, during the truth process in South Africa. And I saw him. He was about the best trauma therapists I’ve ever seen, and I saw him do things that I think happens in some ways, all the time in terms of communities, in that he had people move together, sing together, dance together, pray together and he really was a teacher off, although he would never phrase it away himself of reestablishing synchronicity, in people. And so it’s very clear to me at the core is that where you become traumatized, your whole system gets desynchronized from your environment and from itself basically. Your system gets stuck. And so the question is, how do we unstuck these systems? And sometimes EMDR can be very helpful. But for example, since I wrote my book, I got more negative responses about my EMDR chapter even though I read this very laudatory thing about EMDR, which is a fantastic treatment. And then I said, No, it’s not particularly helpful for early childhood trauma, the curse was in the context of the attachment system. Then I got more angry comments from EMDR people saying, no, it works for everything. No, it doesn’t work for everything, nothing works for everything. And that really bothers me about the whole therapy field is that everybody becomes like religious fanatics, that their own particular method is the method that brings you salvation, no, that just methods that can sometimes be helpful for people. And so that’s been helpful for me, was indeed EMDR. And the notion that you can do something with people that helps the traumatic memory to become a memory instead of a reliving. And EMDR did it extraordinarily well, and I actually said that mainstream psychology, mainstream funders never got interested in EMDR. Because I think EMDR is a fantastically interesting method, in that people are deeply triggered by a particular reliving experience, you do these funny eye movements. And then after a while, people say, it’s over. Yes, it’s happened to me, but it happened a long time ago. So there is something about these weird eye movements. And in our last piece of research with Schwinn Herazian on these presenters, we tried to elucidate it is that they just changed brain circuits, and it really brought home for me is that our job is to change these brain circuits and psychology, psychiatry, both are so way behind what we know about the brain. And the laboratories really don’t listen to conditions about our work. So we have all these different islands that people work on that don’t talk to each other. But anyway, EMDR taught me that you can leave a memory behind. I think Peter Levine, Pat Ogden, the somatic therapist really taught me how it’s in the body. And by moving your body, you can change it. And certainly our research with yoga very much confirmed this. But also to my mind has been extremely helpful for me that they see one of the core components of dealing with trauma is what I learned from Dick Schwarz, his internal family systems therapy, and as we are not a unitary self, William James already talked about it, many people in history have done that. Jung was good at that also. And that is that we may have a part of us that does get enraged, a part of us that cuts ourselves so that part of us that solves our problems by drinking or drugging. But that’s not all of us. To really think about, that we are composed of multiple entities that our executive functioning self needs to put together so that we can organize these internal impulses, but to think about people as in parts and how we survived various things in our childhood and our development, by isolating things, by protecting things, by managing, setting up habits of coping, and acknowledging that some of these habits may be very helpful back then, like starving yourself or cutting yourself, but they’re no longer helpful now and to really deal with this system to really understand how helpful these methods have been to survive, and to allow people to negotiate for themselves to really begin to give up some of these habits.
Keith Kurlander 10:13
Yeah. Well, you mentioned a few things that made me start thinking about anthropology and also more evolutionary theory. I’m curious about your thoughts on taking the conversation around what’s the evolutionary purpose of trauma in humans? Why do so many humans go through this experience, and get stuck in traumatic experiences? And when we look at it more on a timeframe over time, and where we’re at, in humanity right now and how do you frame it in your mind thinking about it from more of that perspective of a lot of people get traumatized, they get stuck in trauma, it’s designed this way for a reason. Well, how do you frame that in your head?
Dr. Bessel Van Der Kolk 10:54
I’m not sure if it’s designed very well, I think by large being a traumatized sort of end stage. And in the wild, if you get traumatized, you stop reproducing, and it’s the end of your life. Basically, it’s not an evolutionary acquisition, basically, it’s the way that the organism survives for the moment by becoming hyper vigilant and, or shutting yourself down. But it doesn’t promote interpersonal contact, it doesn’t promote care of the young, it doesn’t promote community organization, I think it’s really to end stage thing, and is already in our current state of civilization, that we actually think we should be able to heal people from their PTSD so they can have a life and become members of the community. But as by large, good example, pretty speculative is that I have a little cabin up in northern Vermont, no village. It was established in 1790, It was established by veterans of the Revolutionary War. And I think George Washington, very smartly knew that the soldiers who had fought for him would not be helping society to grow. And he gave them 10 acres or 100 acres at the periphery of the American Empire. Go as far as possible, clear the woods, because we don’t want to have you around to raise your kids and to be members of the community because you’re just too wild and unpredictable. And I think that’s what happens when people get traumatized. They really are not, they have a hard time really being productive members of their group. And of course, the advent of trauma therapies, we actually really are in need to help people to overcome those harsh edicts that trauma is sort of the end of your life in a way.
Dr. Will Van Derveer 12:38
Speaking of that, Bessel, regarding going to the edges of society, I’m reminded of when I was in training and Somatic Experiencing Peter Levine’s approach, which I’ve used now for years back in a training we were talking about, we were exploring the issue of shame, and whether shame; one of the trainers was talking about how the circuits; I’m curious if this is true, or if you subscribe to this view that the circuits that run shame and the human neurobiology are also present in animals, in herd animals, what was presented to us was that shame sort of calls the herd or puts the person experiencing severe shame on the edge of the herd so that the predator is more likely to go after the separated animal. And so it conserves the health of the herd to have, I mean, it’s sinister and awful for human beings to sort of drift to the edge of society so they can be picked off by predators, sort of for the benefit of the animal herd is that is there any truth in that, that you know, from a neurobiological
Dr. Bessel Van Der Kolk 13:40
My thinking is, you know, I also enjoyed these speculations about what we like in African savanna. But that’s not really what I observed, that’s not where I lived, what they see is that, of course, when you’re a kid, and terrible things happen to you. But I find useful there is Piaget discovers, namely, the stages of mental development that human beings added when you’re two or three years old, you are the center of the universe, because that’s the only verse you know, and everything good has happened to you have just because of you, and everything bad happens to you because of you also, so if you get beaten up or raped or abused or something, that means you that I’m a terrible person, and that forms your concept of who you are in the world. And it sort of makes you feel like, this is happening to me because I’m terrible. And so that’s one of the largest confrontations we have in the clinical work that we do is these very pervasive feelings of self-loathing, shame, self-hatred, that is the inevitable consequence of early childhood trauma and also the very clear indication that telling people that they shouldn’t be ashamed or it wasn’t their fault or doing anything cognitive doesn’t make any difference in the world whatsoever, except it helps people to understand how crazy it is that they continue to feel this way, but they do as they’re trying to talk people out of feeling ashamed is really not a good way of treating people. And certainly, you should never charge people for understanding how stupid they are for feeling that way. But it’s been fascinating. Today or tomorrow, that’s going to be a big press release from this very Association for psychedelic studies, reporting on the effects of MDMA. And I won’t give you the details, because it’s still confidential. But for me, the most interesting thing in our MDMA research is that people go deeply into trauma on MDMA, on ecstasy, they really learn to love themselves, and learn to really feel like this happened to me, and it happened to me a long time ago. And they come to the conclusion that it wasn’t their fault. So I think the challenge for us as clinicians, which is a very huge challenge, is how do we get people in a deep position of self-acceptance and feeding themselves and experience themselves so they can really see what’s happened to them, they go, like, wow, I was so little. And I was so defenseless, and I was so helpless. And look what was done to me. So you have your adult perspective, for which you can look at that kid who you once were, and just make that connection with that wounded part of yourself. And I think things like IFS, internal family systems therapy, are also helpful with that. I find neurofeedback to be helpful with that by changing these brain circuits. And I think it’s very important for clinicians to really work very hard on seeing what works best for those people. And that means oftentimes giving up your preferred treatments, and finding another treatment that what you do already.
Dr. Will Van Derveer 16:54
And that’s one of the things that I have so admired about your work, Bessel is your willingness to continually modify your perspective on what works and to continually open your mind to new and different ways of healing trauma. Well, I feel a parallel in my early adoption of EMDR, and then finding in my experience some limitations with early developmental trauma with EMDR. And then going in training with Peter Levine. And then eventually, I was part of a MAPS study, phase two study here in Boulder. And I was able to be a study physician, but also more interestingly, one of the therapists and so the natural emergence of parts work. And the utility of somatic therapy on MDMA, to me seems lightyears ahead of working, in my experience with IFS, or somatic experiencing, without MDMA, for these more stubborn chronic cases of trauma, quite incredible to see people healing themselves, essentially, with the right kind of holding space. So thank you for bringing the MAPS. We look forward to the release.
Dr. Bessel Van Der Kolk 18:02
But it seems like you said to me that you brought your Somatic Experiencing background into your MDMA session that hasn’t happened yet, in the trials and somatic experiences not yet part of the protocol. But I’m very much encouraged by colleagues in the field, to give them somatic components, because really feeling with your body releases there is terribly important also.
Dr. Will Van Derveer 18:26
And there’s much to be done in the future with exploring these different combinations of therapeutic techniques. It seems like you have also focused quite a bit on post traumatic growth, especially in regards to helping people how they can grow after trauma, how they can perhaps even be more well than they were prior to trauma.
Dr. Bessel Van Der Kolk 18:48
I have a visceral reaction against that term.
Dr. Will Van Derveer 18:52
Against post traumatic growth?
Dr. Bessel Van Der Kolk 18:53
Yeah, because I’ve always seen it as coming from people who had a hard time, like I did for them to come to this horror about trauma. And so I’ve always seen it as sort of, oh, let’s be chirpy about bad things. Because it’s so hard to really, really feel and allow yourself to experience horrendous trauma. I don’t like to pre-post traumatic growth. But on the other hand, what makes us where possible, is the life force. And what we see in the traumatized people I work with is astonishing courage, to go on with your life despite everything, and this needs to survive. And this drive to live despite all of this is really the engine of humanity in a way. And so doing this work really confronts you with people who are heroic in terms of being able to go on despite everything attached to them. And I like to go on the non-scientific level and go as far as to say that all the great advances in humanity have probably been forged by traumatized people, because if you’re not traumatized life is okay the way it is, why should you make any changes? Because when you’re traumatized, you have to find new solutions. And when you look at the biography of somebody like Isaac Newton, his early childhood, you go like, Oh, my God, how come he didn’t end up being locked away for the rest of his life. And he was a crazy guy who happened to invent physics and mathematics and invent science. And I think what often happens is that traumatized people find unusual and very creative ways to carve out a living for themselves, that doesn’t mean that they’re happy people. It doesn’t mean that they’re filled with pride and joy about the great discoveries that are a good contribution. They may be still miserable, but whatever they do is a way of expressing their life force. Once we start seeing our patients through that lens, we become much more compassionate about who they actually are.
Keith Kurlander 21:02
In order to return to the thread here of medicines, MDMA, different types of medicines and get your thoughts on what role, if any, do conventional psycho-pharm have in PTSD? And then also, what role do you see psychedelics potentially playing in PTSD treatment? And how are you thinking about medications overall, right now?
Dr. Bessel Van Der Kolk 21:27
Well, you know, as I write about in my book, I was part of that first generation ever to discover psychotropic drugs and thinking that we’re the answer. And so I did the first studies on Prozac for PTSD, sort of PTSD, propel of PTSD, and we were filled with optimism. It turns out, it didn’t work all that well, what’s particularly striking to me is that we did a study at the Thomas Center, which my center which is civilian and half of the study was the VA half of the traumas. And the people the VA didn’t budge. But va culties to be the largest prescriber of psychotropic agents, and study after study shows, it doesn’t work. So we’re spending billions of dollars bamboozling people into taking medications that really don’t do the job. And it’s really astonishing to me that people don’t say, okay, it doesn’t work, let’s find something else. That doesn’t mean the psychotropic agents may they’ll be helpful people, I have my license, I prescribed from time to time I SSI as a fiscal stimulus, I just tried alpha and energy blockers, they have a small role to play in helping people go, the big thing that we have learned that we really didn’t know back then is that we have these inborn self-regulatory systems, and the way that we breathe and the way we move and the way that we’ve been touched, and we move our body has dramatic effects of self-regulation. And it is tragic that in our capitalist system, where everything needs to be based on how much money you make, all of these non-money-making systems of breathing, moving, yoga meditation, really have not taken off, and are dismissed as alternative therapies. Now, this is who we are, we are moving breathing creatures. And to my mind, my dream is that every school system in America, from k to 12, we have the four R’s, reading, writing, arithmetic and self-regulation, and that every week, every kid in America, foods and tech education, learns how to regulate themselves alerting mechanism, self-regulation, because it can be done and will get us out of this pathetic drug addicts, a society that we live in. But you know, there’s room for medications, I’ve nothing against them. They have their role, but it’s very important to assess is this working for you is your life better, and much of the time it isn’t, and then come in psychotropic agents is psychedelics, and of course psychedelics is a whole different issue, because it’s not you give people psychedelics, to maintain them and to allow them to tolerate that stuff. You give psychedelics in order to create a new mindset. And the great thing about all of these agencies, it puts you in a completely different frame of mind, but you’re traumatized. You live in a very narrow, constricted reality, and your fear and your terror and your rage is all there is. Our president’s current president is almost over poster child for all this stuff, and we really should see this and his followers probably also, they have this narrow reality of I’m threatened and terrible things happening to me. And then what do these agents do? They open up the universe. You start seeing and experiencing things you have never seen before you have never experienced before. And you go into the state of Oh my god, the universe is so much larger. You know what my little mind has been able to do at concerts, and you start opening up your mind to explore other ways of being in the world. And most of these agents also gives you a sense of, Oh, I’m a part of this gigantic universe. And I have my own role to play. But I’m just a very small part of a larger hole. And other thing all these agents give you a sense of awe about the complexity of where you live, and the relative insignificance and significance of you in the larger reality, as it gives you a larger context. And these are momentary experiences. These are not things you do on a regular basis. In the studies we do we have three sessions, I don’t feel great about it. I wish we had an option to do anything between two sessions and 10 sessions, which in reality we do, but of the people I know who work in the substances, I think I can call them pretty much at any time. And I don’t think they’ll pick up the phone and say, Sorry, I’m gonna ask your pride now, I’m very sorry, I’m on drugs, because these drugs are very powerful experiences, and you set the time aside to go through it, but you don’t do it lightly. You don’t do recreation at all.
Keith Kurlander 26:19
How do you formulate in your mind treatment plans with these medicines, these psychedelics that hopefully are coming? Assuming they get through phase three? And for you? Is it there’s certain people that will do their psychedelic treatment plan? And they’ve moved through their trauma and they move on with their life? Or is it a more integrated treatment plan that you see these fitting into first for many people that take months or years to move through?
Dr. Bessel Van Der Kolk 26:45
That’s a very good question. I haven’t really thought about it. In my own practice, I’m simply prepping a bunch of my own patients, for the moment, it becomes legal for them to have these experiences. And I think that the therapy that we have done up to now will really help them to have a much richer experience than if they hadn’t done it. But by and large, a secret people are done with a psychedelic experience, they are dumb usually you don’t go let’s do a lot of shifting gears of psychoanalysis after that, to discover how it will change our practices, but I think it certainly cuts. I think a lot of people stay in therapy for a long time because they can’t move and what once these drugs really open people up, they really come to certain resolutions. The great concern I have is again, that in the culture we live in, is the quick answer and the magical answer and this the right drug, and what they see already happening with ketamine, for example, is you have all these ketamine clinics, people are giving their ketamine has sent off to all departments to take these drugs. I am horrified by that. What we do in our MAPS studies is ketamine assisted psychotherapy, MDMA assisted psychotherapy, that create a context where people can safely go into an altered state of consciousness with people around you, who are really there for you, or hold you. These experiences are not fun and games, like going deep into your trauma is always horrendously painful and terrifying. And having people around you who are there for you, who look benignly at you, who don’t intrude on you, but really are there to hold you is terribly important. And I really honor Rick Doblin of MAPS, Vilnius Angiopoietin, behind all this, of insisting that whatever work we do is going to be done in a very, very carefully held environment. And that’s how people at Hopkins are doing it and people are doing it. And that’s the right way to do it. It’s not a shortcut to really be there for people.
Dr. Will Van Derveer 28:59
I couldn’t agree with you more. And Keith and I also run a ketamine-assisted psychotherapy clinic where we insist that the patient is held with the right set and setting with a psychotherapist throughout the entire process. And with a physician on site to make sure that any safety issues are covered.
Dr. Bessel Van Der Kolk 29:20
Experiencing what you’re experiencing, like your kid with his parents. Sure, like kids have nightmares, you know, and, and I can manage a nightmare.
Dr. Will Van Derveer 29:31
One question that comes up for me around MDMA assisted psychotherapy for PTSD is the trial that I was a part of, we had people who had decades of therapy. prior to entering the trial. One person had over 1000 sessions of therapy previously, and I’m wondering about your thoughts, where we might intervene with MDMA assisted psychotherapy for PTSD? Are we going to use it as a frontline agent or is it going to be a thing that someone has to to try and fail a number of other therapies before they have access to that, what are your thoughts on that?
Dr. Bessel Van Der Kolk 30:05
I think it’s too early to tell, you know, the great issue right now is that all these drugs right now are still illegal except for ketamine. And so I think the question for MAPS more than other people is, they’ll be training enough people to be able to provide good therapy, and how will we organize ourselves to really take care of the demands? And then very curious how it will work itself out. And it’s always there’s so many factors involved in that. I think we’ll just see how it goes. But I hope it’s done in a very carefully controlled way. But I think a lot of people I’ve seen over the years, would really benefit from it. And I think it may change, I think it’s going to change the whole therapy field in a profound way.
Dr. Will Van Derveer 30:51
Yeah, and it’s such a unique therapy, because we’re talking about completely seamless interplay between MDMA and the psychotherapy itself, which is such a huge shift in the thinking, right, it’s a shift for FDA to be thinking about that as they consider whatever they’re going to be considering from phase three, it’s a huge change for therapists to be thinking about, too.
Dr. Bessel Van Der Kolk 31:15
I do a lot of supervision these days via zoom. And I meet therapists all the time, who tried to fix people, and who tried to change their behavior, to manage people. And I go, like, you know, I’ve never been able to manage anybody, I can barely manage myself, and like, how can you manage other people’s behavior, I am really astounded by that. And there’s one thing about MDMA assisted therapy, or any of those things, if you don’t manage anything, you’re just all you do is create a safe environment where people come up with their own solutions and all this, I’m going to make sure that you never get angry with your wife again. That time hopefully is over like, and it’s been a very bad direction towards the therapy. And people try to please the insurance company. So yeah, I got this person to behave better.
Dr. Will Van Derveer 32:05
I have to admit, as a psychiatrist entering the world of MAPS, I had to unlearn some habits there, of trying to take responsibility for the healing process in a way that is extremely different from what the protocol is that MAPS is working with, which I think is so exciting, because it places the empowerment so deeply in the patient,
Dr. Bessel Van Der Kolk 32:25
It’s your life you know, you need to find out how you want to live your life and what your options are, and what your capacities are that you have, which are very different from what I have.
Keith Kurlander 32:35
Do you have your eyes on anything that’s to come decades from now in trauma therapies that we know very little about right now but your kind of washing example would be like virtual reality or things that we might have access to, as the technologies get better over time that you’re just kind of watching and wondering, like, Where are we headed in two decades, three decades from now and trauma work?
Dr. Bessel Van Der Kolk 32:57
I have two dimensions here you know, because my book, I daily get numerous requests for referrals. Now some people refer to people because there are very few conditions, no more than one thing. And for me, right now, if every condition would learn sensory motor therapy, and IFS, and EMDR and really good time for processing verbal stuff. There is a long way but very few people do this. And so, for now, learn what’s available and you’ll become a much better therapist. You don’t have to go much beyond that. My other piece of research is in neurofeedback, and is this intriguing? Well neurofeedback is not as sexy as psychedelic therapy is, I think it is much larger public health potential. And there’s at least half a million kids in America who are being abused and neglected at home who cannot learn because their trauma and one thing I’m actually working on here in Berkshire County, where I live right now is to get in neural feedback system in every school where kids can be trained to train their own brainwaves. And I think neurofeedback is a, what it is, is that you put electrodes on people’s skull, you harvest the brainwaves underneath it, you can create a map of the brain fairly quite cheaply. You can see what part of the brain is talking to what you can hook it up to the computer, and you can play computer games with your own brainwaves to view certain patterns and to inhibit other patterns is very effective. I’ve done though, four studies in the subjects all of which came out very well. have gone to NIMH four six times to get funding. They refuse to fund any of the studies. I think neurofeedback is a huge thing for the future, when you start looking at these brain scans this quantitative EEG You see how the back of the brain is supposed to be really calm, sort of monitoring your bodily self is just going crazy. You see these abnormal brain waves, you see different parts of the brain not talking to each other. When you see these maps, you go like, oh, you’re doing remarkably well, if you’ve only tried to commit suicide 15 times, because we can see how disturbed these brains are. It’s really stunning. And so we have the technique to regulate these brainwaves. And with people’s behavior to a large degree, but boy, has it been extremely difficult to get it organized and get funded, etc, etc. But I think that’s a very important part of the future, is to really do applied neuroscience. And applying all this up, I’ve learned about all the different parts of the brain that get messed up by trauma at various ages is developing, and how you can activate is really grateful to hear.
Keith Kurlander 35:59
And are you looking at in your what you’ve looked at with neuro Are you looking into, actually, let’s say we take for example, somebody that’s got some pretty serious, complex PTSD or something like that just serious PTSD Are you have you been looking into, like actually how to use neuro to increase regulation and inhibition in the brain, or you will look at more like the injuries that come from that? What comes from that over time, like the learning issues and things like that?
Dr. Bessel Van Der Kolk 36:29
I think DSM was a fun thing, when we first put together back in 1980, has become an abomination. Actually, it’s a list of symptoms that don’t exist, like pseudoscience type of stuff. But you’re dealing with people who are confused, people who can’t concentrate, people can focus, people can’t control their effective systems, people have poor executive functioning, and so get measuring, indeed, how well, people can organize their lives and organize their relationships with other people. And when you really look at brainwaves, you can really see when you look at the quantity VEG’s, you have a fairly good understanding about your anatomy. Oh, that’s why you have a hard time focusing or that’s all it is where you have a hard time sleeping, or that’s why you have a hard time staying on track, because that’s not talking to this. And so I really hope it’s over time, psychiatry, such a sad profession, will become real scientists again, and actually learn that neuroscience and learn but we have learned about the brain and applied it to clinical practice.
Dr. Will Van Derveer 37:39
Now, it’d be nice to examine the organ that we treat in psychiatry.
Dr. Bessel Van Der Kolk 37:44
Yeah, maybe the other part of that, of course, is that we don’t only see that organ because we human beings are such deeply intertwined creatures. We are social creatures. And so we also need to really look at how we relate to other people, how we interact with other people, how much conferencing gets from each other, etc. And to a large degree in our paradigm, we still focus on people as individuals, but this members of a tribe or a group, and that’s a distortion of reality, of course, the reality is that none of us exists by ourselves, all of us are, could be intertwine as the people around us and arborologist intertwine into people about us.
Dr. Will Van Derveer 38:29
Absolutely. Yeah, I agree. And we’re social animals, and relational field is a critical element of our health, or lack thereof, depending on what we see, I think what we see as possibilities from childhood trauma can greatly limit what our actual experiences as adults in relationship and before we move on from the neurofeedback, I just had one more question for you Bessel about one of the things that we’ve been thinking about with our clinic. Is there a role for neurofeedback in the integration process that can follow, for example, ketamine assisted psychotherapy, or eventually perhaps MDMA assisted psychotherapy as a way of reinforcing these new connections and neural pathways? Is that something that you’re considering?
Dr. Bessel Van Der Kolk 39:13
I think I’m too far on the downward slope of my development to do that work. I mean, I think it’d be great this work to do actually, what can ketamine do? What can neurofeedback do? Is it harder to reinforce each other, be a really worthwhile project to look into, to what degree do the same thing so I’ve had some extraordinary successes of people with horrendous chronic trauma, who are always dissociating and spacing out and unable to focus now but unable to feel themselves were on the repeat activity became and found themselves they found their identity, found their core. And as I see people do extraordinarily well on neurofeedback. That may also be true for ketamine. I’ve not seen those results in ketamine, I’m still puzzled about ketamine. What can I do? What can I do? I’ve had my own ketamine experiences, the NFP also very befuddled about. So these are questions that we need to ask and answer.
Keith Kurlander 40:21
Yeah, makes sense. Well, let’s wrap up, we asked this to every guest on the show, we asked if you had a billboard that every human would see once in your life, and it had a paragraph on there, what would you like them to know?
Dr. Bessel Van Der Kolk 40:34
Many different things on my mind, actually, one of the things that comes to my mind is something Dick Schwartz likes to say, and that is. If you knew the background of the people you dislike and hate, you knew what their corporate was, you’d have a great sense of empathy for it. And that we all go to the same experiences, that we’re all in the same boat in a way. And even the most assertive person, you know, is dealing with the same issues as you’re dealing with, and the things that we have in common, and how kind a connection is everything.
Dr. Will Van Derveer 41:14
Very beautiful. Thank you.
Keith Kurlander 41:16
Thank you, for being on the show.
Dr. Will Van Derveer 41:20
Thank you for all the pioneering work that you do and continue to do.
Dr. Bessel Van Der Kolk 41:24
Good luck to you. Okay.
Dr. Will Van Derveer 41:26
Thank you so much for your time. Wow, that was such a fun conversation for us, and we hope that you enjoyed it as well. We look forward to connecting with you again on the next episode of the higher practice podcast where we explore what it takes to achieve optimal mental health.